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Table 6 Summary of findings

From: Management of sexual dysfunction in breast cancer survivors: a systematic review

Systemic Therapy Interventions
Reference Outcomes Intervention results Control results Comparisons Quality of evidence (GRADE) Comments
Barton (2007) [34] All measures normalized to 100 point scale: Mean change (95 % CI): Mean change (95 % CI): 1. p = 0.58 Moderate • Dropout: 12 %
1. 5.5 (2.2-8.8) 1. 4.4 (2.4-6.5) 2. p = 0.11 • Side effects and quality of life did not differ by group.
1. Sexual desire (CSFQ desire subscale) 2. 9.4 (7.0-11.2) 2. 4.7 (0.4-9.0) 3. p = 0.14
2. Pleasure (CSFQ pleasure subscale) 3. 5.7 (4.1-10.6) 3. 3.4 (2.1-6.8) 4. p < 0.001 for both measures
3. Sexual function (CSFQ total score) 4. Total 92.8 (74.9-110.7) 4. Total 1.2 (-1.8-4.3) 5. p = 0.82
4. Serum testosterone, ng/dL Free 1.6 Free 0.18 (-0.1-0.5) 6. p = 0.11
5. Serum estradiol, pg/mL (1.2-2.0) 5. 0.5 (-5.2-6.1) 7. p = 0.93
6. Serum SHBG, nmol/L 5. -0.3 (-2.9-2.4) 6. -0.3 (-3.0-2.3)
7. Serum AST, U/L 6. -3.1 (-5.1- -1.0) 7. 0.2 (-1.1-1.5)
7. -0.23 (-1.3-0.8)
Buijs (2009) [42] 1. Sexual function (Sexual Activity Questionnaire) 1. Venlafaxine: No change 1. No control 1. Not reported Moderate • Dropout: 33 %
Clonidine: No change
Nunez (2013) [41] 1. Sexual function (Arizona Sexual Experience Scale) Pre- to post- difference (SD): Pre- to post- difference (SD): 1. p = 0.5 Moderate • Dropout: 11 %
1. 1.4 (3.8) 1. 0.6 (3.4)
Physical activity interventions
Berglund (1994) [45] 1. Sexual problems frequency (Scale 0-4) Pre, post, 3-month mean scores (SD): Pre, post, 3-month mean scores (SD): 1. Not significant High • Dropout: 8 %
1. 0.7 (1.2), 0.6 (1.0), 0.5 (1.0) 1. 0.6 (1.0), 0.5 (0.9), 0.4 (0.7)
Duijts (2012) [43] 1. Sexual function (Sexual Activity Questionnaire, habit subscale) Baseline, 12-week mean scores (SD): Baseline, 12-week mean scores (SD): Effect size (intervention to waitlist control at 12 weeks): Moderate • Dropout: 17 %
• Significant under-compliance:
1. CBT: 0.3 (0.8), 0.5 (0.8) 1. 0.6 (0.8), 0.6 (0.8) 1. CBT: 0.31, p = 0.13
PE: 0.6 (0.8), 0.6 (0.8) PE: 0.01, 58 % CBT; 64 % PE;
CBT/PE: 0.4 (0.8), 0.5 (0.8) p = 0.97 70 % CBT/PE
CBT/PE: 0.15,
p = 0.44
Speck (2010) [44] 1. Self-perception of appearance and sexuality (Body Image Relationships Scale appearance and sexuality subscale) Mean % change (SD): Mean % change (SD): 1. p = 0.004 Moderate • Dropout: 21 %
1. 7.3 (16.6) 1. -0.7 (18.1)
Individual-based counseling and educational interventions
Allen (2002) [55] 1. Sexual health (CARES sexual subscale) Baseline, 4-month mean scores (SD): Baseline, 4-month mean scores (SD): 1. p > 0.05 High • Dropout: 9 %
2. p > 0.05
2. Marital relationship (CARES marital subscale) 1. 2.2 (1.1), 2.1 (0.9) 1. 2.0 (1.0), 2.0 (0.9)
2. 1.8 (0.8), 1.7 (0.7) 2. 1.6 (0.7), 1.5 (0.6)
Anderson (2015) [46] 1. Sexual function (sexual function subscale, Greene Climacteric Scale) Baseline, 12-week mean score (SD) and effect size Cohen’s d: Baseline, 12-week mean score (SD) and effect size Cohen’s d: 1. p = 0.05; Moderate • Dropout: 9 %
Cohen’s d 2 of post-intervention scores = 0.10
1. 2.0 (1.0), 1.3 (1.0) 3. 1.6 (1.1), 1.4 (1.0)
d = 0.65 d = 0.18
Ganz (2000) [48] 1. Menopausal Symptom Scale Score (hot flash, vaginal and urinary subscales of BCPT Symptom Checklist) Mean change score (95 % CI): Mean change 1. p < 0.01 Moderate • Dropout: 5 %
1. 0.57 score (95 % CI): 2. p = 0.03 • Both groups used educational materials.
(0.40-0.74) 1. 0.09
2. Sexual health (sexual summary subscale of CARES) 2. 0.46 (−0.04-0.21) • Intervention group more likely to receive pharmaco-logic and behavioral interventions.
(0.30-0.62) 2. 0.11
(−0.16-0.38)
Germino (2013) [56] 1. Sexual function (Medical Outcomes Study – Sexual Functioning) Mean score (SD) at baseline, 4-6 months, 8-10 months: Mean score (SD) at baseline, 4-6 months, 8-10 months: 1. p = 0.03 at 4-6 months follow up Moderate • Dropout: None
• Single time point statistically different without adjustment for baseline differences.
1. 2.1 (1.0), 2.0 (1.0), 2.0 (1.1) 1. 2.3 (1.1), 2.3 (1.1), 2.2 (1.1)
Greer (1992) 1. Sexual relationships (subscale of Psychological Adjustment to Illness Scale) Mean difference (SD) from baseline to 8-weeks, to 4-months: Mean difference (SD) from baseline to 8-weeks, to 4- months: 1. p = 0.53 at 8-week, p = 0.47 at 4-months Moderate • Dropout: 21 %
1. 0.7 (7.2), -1.3 (7.7) 1. -0.4 (8.1), -1.4 (8.2)
Jun (2011) [49] 1. Marital intimacy (Martial Intimacy Questionnaire) Change in mean (SD) scores: Change in mean (SD) scores: 1. p = 0.29 Low • Dropout: 25 %
1. +2.0 (5.0) 1. +0.6 (2.1) 2. p = 0.45
2. Sexual interest (subscale, CARES) 2. -0.2 (0.6) 2. -0.1 (0.9) 3. p = 0.53
3. Sexual dysfunction (subscale, CARES) 3. -0.1 (1.0) 3. +0.1 (1.1) 4. p < 0.001
4. Sexual satisfaction (Sexual Satisfaction Scale) 4. +5.3 (9.0) 4. -3.4 (5.8)
Marcus (2010) [57] 1. Sexual function, (behavioral, evaluative and body image subscales of Sexual Dysfunction Scale) Baseline, 12- and 18-month mean scores (approximated from figure): Baseline, 12- and 18-month mean scores (approximated from graph): Comparison by intervention group: Moderate • Dropout: 20 %
1. 47, 40, 40 1. 45, 43, 43 1. p = 0.03 at 12-month,
p = 0.04 at 18-month
Rowland (2009) [51] Likert scales: Mean change in score (SD): Mean change in score (SD): Per-protocol comparisons: Low to very low • Dropout: 56 %
1. Satisfaction with variety of sexual activities 1. 0.1 (1.2) 1. -0.03 (1.0) 1. p = 0.23 • Intervention group: 89/284 (29 %) agreed to participate; 72/284 (25 %) attended ≥ 1 session.
2. 0 (1.5) 2. -0.3 (1.0) 2. p = 0.02
2. Relationship satisfaction 3. 0.7 (1.5) 3. -0.1 (1.7) 3. p = 0.09
3. Dyspareunia 4. 0.3 (1.4) 4. 0 (1.1) 4. p = 0.29
4. Pain interferes with pleasure 5. Not reported 5. Not reported 5. p = 0.03
5. Improved comfort with sexuality
Salonen (2009) [58] 1. Sexual functioning (subscale 0-100, EORTC QLQ-BR23) Mean score (SD): Mean score (SD): 1. p = 0.2 High • Dropout: 9 %
1. 29 (26) 1. 24 (22)
Schover (2006) [52] 1. Sexual Dysfunction (FSFI) 1. Not reported 1. Not reported 1. No difference Very low • Dropout: 20 %
Schover (2011) [53] 1. Sexual Dysfunction (FSFI) 1. Not reported 1. Not reported 1. No difference Very low • Dropout: 38 %
Vos (2004) [60] 1. Sexual function (subscale, QLQ-BR32) 1. Not reported 1. Not reported 1. Regression coefficient comparing intervention to control: -0.17 (p > 0.05) Low • Dropout: 21 %
Couple-based counseling and educational interventions
Baucom (2009) [47] 1. Marriage quality (Quality of Marriage Index) Baseline, 12-week, 12-month mean score (SD): Baseline, 12-week, 12-month mean score (SD): Effect size of treatment to controls: Low • Dropout: 14 %
2. Sexual function (Derogatis Inventory of Sexual Functioning) 1. Female: 34.0 (13.6), 39.3 (4.7), 39.7 (3.5) 1. Female: 40.8 (6.0), 42.2 (4.1), 40.2 (5.1) Baseline to 12-weeks
Male: 39.3 (6.6), 39.6 (5.9), 39.6 (5.2) Male: 42.5 (3.0), 37.5 (13.6), 41.0 (6.2) 1. Female 0.48
Male 0.64
2. Female: 11.5 (5.0), 12.7 (4.1), 13.0 (3.1) 2. Female: 10.3 (4.8), 9.8 (5.8), 9.8 (5.9) 2. Female 0.34
Male 0.38
Male: 12.4 (1.5), 13.9 (2.8), 13.2 (2.4) Male: 12.0 (3.9), 12.3 (2.8), 9.4 (4.5) Baseline to 12-months
1. Female 0.77
Male 0.34
2. Female 0.42
Male 1.04
Christensen (1983) [61] 1. Sexual satisfaction (Sexual Satisfaction Scale) Post-test mean score (SD): Post-test mean score (SD): 1. p < 0.05 for both partners High • Dropout: None
1. Female partner: 80.4 (31.5) 1. Female partner: 69.0 (20.2)
Male partner: 81.3 (28.7) Male partner: 67.3 (28.6)
Kalaitzi (2007) [50] 1. Sexual desire frequency Baseline, 12-week mean scores (95 % CI): Baseline, 12-week mean scores (95 % CI): 1. p = 0.73   • Dropout: None
2. Intercourse frequency 2. p = 0.14
3. Masturbation frequency 1. 2.9 (2.3-3.4), 2.8 (2.3-3.2) 1. 3.0 (2.6-3.4), 2.7 (2.2-3.1) 3. p = 0.32
4. Orgasm frequency 2. 3.2 (2.7-3.6), 2.9 (2.5-3.3) 2. 3.2 (3.0-3.4), 2.5 (2.1-2.9) 4. p = 0.03
5. Initiative for sex 3. 1.9 (1.4-2.3), 1.6 (1.2-2.0) 3. 1.9 (1.6-2.2), 1.9 (1.5-2.2) 5. p < 0.001
6. Satisfaction with relationship 4. 3.3 (2.8-3.8), 3.7 (3.4-4.0) 4. 3.6 (3.1-4.0), 3.1 (2.6-3.6) 6. p = 0.01
5. 2.2 (1.8-2.6), 2.7 (2.3-3.0) 5. 2.6 (2.2-3.0), 1.8 (1.4-2.2)
6. 3.8 (3.3-4.2), 4.5 (4.2-4.7) 6. 3.3 (2.9-3.7), 3.7 (3.2-4.1)
Schover (2013) [54] 1. Sexual function (FSFI) Linear mixed model coefficients, post-treatment versus baseline: Linear mixed model coefficients, post-treatment versus baseline: 1. p = 0.024 Low • Dropout: 36 %
2. Sexual satisfaction (Menopausal Sexual Interest Questionnaire) 2. p = 0.01
1. 7.4 1. 2.8
2. 13.2 2. 3.4
Scott (2004) [96] 1. Sexual Self Schema Scale Baseline, post-treatment mean score(SD): Baseline, post-treatment mean score (SD): Effect size, p-value of couples coping vs other two conditions: Moderate • Dropout: 11 %
2. Sexual desire (subscale, Brief Index of Sexual Function) Couples coping Medical information 1. d = 0.8, p < 0.05
3. Sexual arousal (subscale, Brief Index of Sexual Function) 1. 57.3 (13.5), 62.8 (12.2) 1. 55.4 (14.3), 55.8 (11.0) 2. No difference
2. 4.2 (2.8), 4.0 (2.3) 2. 3.1 (1.9), 2.4 (2.4) 3. No difference
3. 2.7 (2.5), 2.0 (2.0) 3. 1.9 (1.4), 1.6 (1.6)
Patient coping
1. 55.7 (14.3), 56.0 (12.0)
2. 3.7 (2.6), 2.7 (2.9)
3. 3.1 (1.6), 2.2 (2.3)